The neglect of the elderly in the NHS will be targeted this week under new guidelines forcing hospitals to respect patients' dignity.

Professor Ian Philp, the government 'tsar' on services for old people, admitted pressure to treat more patients had meant elements of basic care were being left behind.

Breaches of respect - shouting at patients, failing to ensure they are properly fed and clothed, or allowing them to soil themselves - will in future be treated as seriously by health watchdogs as failure to meet waiting-time targets, he said.

The new standards follow a string of reports revealing how elderly patients have suffered malnutrition when meals were whisked away before they could eat them, or been shunted between wards for no medical reason. The worst cases involved emotional or physical cruelty.

'Things happen to older people that, if they happened to children, would end up in the criminal courts, but don't even get mentioned: they're swept under the carpet,' Philp told The Observer

'I had a lady in my outpatient clinic who had two broken arms and I couldn't find out from her notes what had happened. She told me, "That's what happens if you speak up for yourself." It happened to her, she said, in a care home.'

Such cases should be prosecuted, he said, but the everyday humiliations of thoughtless or disrespectful care would be tackled by a tougher inspection regime.

Checks by the NHS Healthcare Commission will now cover 'dignity' issues, he said. Hospitals will be expected to encourage patient complaints and view breaches of dignity as, 'as much of a system failure as a breach of a four-hour wait in an emergency unit,' with the same sanctions. These mean hospitals can be downgraded in national ratings and, in the worst instances, face intervention to improve their performance.

However, there will be no extra money to pay for enforcing the new regime, which will be a tough task because two-thirds of adult patients in acute hospitals are now over 65.

Gordon Lishman, director of Age Concern, welcomed the moves but called for 'a commitment by the government that money to deliver services is available', adding: 'Not one more older person should suffer undignified, inequitable or disconnected healthcare.'